What is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written document that healthcare providers are required to give uninsured and self-pay patients before scheduled non-emergency services. It must list the expected charges for the primary service and any reasonably expected related items or services — including fees from other providers involved in your care.
The requirement was introduced as part of the No Surprises Act and took effect on January 1, 2022. It is a federal law, not a guideline.
Who is entitled to a Good Faith Estimate?
Uninsured patients — anyone without health insurance is entitled to a GFE before any scheduled service.
Self-pay patients — patients who have insurance but choose to pay out-of-pocket for a particular service are also entitled to a GFE.
Insured patients — the formal GFE dispute process applies specifically to uninsured and self-pay patients. However insured patients can and should still request cost estimates before scheduled procedures and use them as a baseline when questioning final bills.
What a Good Faith Estimate must include
- Expected charges for the primary item or service
- Expected charges for any items or services reasonably expected in connection with the primary service (anaesthesia, lab work, facility fees etc.)
- The name and contact details of any other providers expected to be involved
- A diagnosis code if available
- The date the estimate was created
What to do if your bill is $400 or more higher than your GFE
You have the right to use the federal Patient-Provider Dispute Resolution (PPDR) process. Here is how it works:
- Contact the provider first and explain the discrepancy. Many billing errors are resolved at this stage.
- If the provider does not resolve it, submit a dispute through the federal PPDR process. You can access this at CMS.gov or call 1-800-985-3059.
- An independent dispute resolution entity reviews the case and determines whether the final charges were appropriate.
- The fee to initiate the PPDR process is currently $25 for patients.
You must request a GFE — providers do not always offer it automatically. If you are uninsured or self-pay, ask for a Good Faith Estimate before any scheduled service.
The $400 threshold applies to the total estimate, not individual line items. If your total bill exceeds your total GFE by $400 or more, you qualify for the dispute process.
Keep your GFE. You cannot dispute the bill against an estimate you no longer have. Store it with your other medical documents.
Got a bill that looks higher than expected?
Upload your bill and any estimate you received. Get a clear analysis of the discrepancy and a ready-to-use dispute letter.
Upload your bill — it's free →The provider violated federal law. You can file a complaint with the No Surprises Help Desk at 1-800-985-3059 or through CMS.gov. Providers face civil monetary penalties for failing to provide required GFEs.
No — it is an estimate, not a binding contract. But if your final bill is $400 or more higher than the GFE total, you have the right to dispute it through the federal process. The estimate is a meaningful protection, not just a suggestion.
The formal GFE dispute process applies to uninsured and self-pay patients. If you have insurance, your dispute would typically go through your insurer's appeals process. However you can still reference any cost estimate you received when disputing the patient responsibility portion with the provider directly.